title: Are patients at nutritional risk more prone to complications after major urological surgery?
abstract: OBJECTIVE
  The nutritional risk score is a recommended screening tool for malnutrition. While a nutritional risk score of 3 or greater predicts adverse outcomes after digestive surgery, to our knowledge its predictive value for morbidity after urological interventions is unknown. We determined whether urological patients at nutritional risk are at higher risk for complications after major surgery than patients not at nutritional risk.
  
  
  METHODS
  We performed a prospective observational study in consecutive patients undergoing major surgery. A priori sample calculation resulted in a study cohort of 220 patients. Interim analysis was planned after 110 patients. The nutritional risk score was assessed preoperatively by a specialized study nurse. Nutritional care was standardized in all patients. Postoperative complications were defined previously using the standardized Dindo-Clavien classification. The primary end point was 30-day morbidity. Univariate and multivariate analysis was performed to identify predictors of complications.
  
  
  RESULTS
  The study was discontinued due to significant results after interim analysis. A total of 125 patients were included in analysis from June 2011 to June 2012 and 15 were excluded because of incomplete data. Of 51 patients at nutritional risk 38 (74%) presented with at least 1 complication compared to 28 of 59 controls (47%). Patients at nutritional risk were at threefold risk for complications on univariate and multivariate analysis (OR 3.3, 95% CI 1.3-8.0). Cystectomy was the only other predictor of morbidity (OR 10, 95% CI 2-48).
  
  
  CONCLUSIONS
  Patients at nutritional risk are more prone to complications after major urological procedures. Whether this increased morbidity can be reversed by perioperative nutritional support should be studied.
authors.affiliation: Urology, University Hospital Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. Electronic address: yannick.cerantola@chuv.ch.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Cerantola
authors.forename: Massimo
authors.initials: M
authors.lastname: Valerio
authors.forename: Martin
authors.initials: M
authors.lastname: Hubner
authors.forename: Katia
authors.initials: K
authors.lastname: Iglesias
authors.forename: Laurent
authors.initials: L
authors.lastname: Vaucher
authors.forename: Patrice
authors.initials: P
authors.lastname: Jichlinski
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000150:complications* / Q000453:epidemiology; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013520:Urologic Surgical Procedures
keywords: BMI; NRS; body mass index; complications; malnutrition; nutritional risk score; risk; surgery; urology